Catatonia and consultation-liaison psychiatry study of 12 cases

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Abstract

Nowadays, catatonia is no more considered as a subtype of schizophrenia. Catatonia seems more frequently associated to mood disorders as well as general medical conditions. It is sometimes difficult to associate formally a medical etiology to this syndrome. But we found, in the literature, three groups of associated general medical conditions: neurological disorders, drug induced and toxic induced conditions, metabolic conditions.

We present a prospective study of 12 clinical cases of catatonia due to general medical conditions we realized in the Consultation-Liaison Psychiatry Department of the University Hospital of LILLE (France) during a period of 5 months.

We find coherent data with the literature. However, our results suggest that if medical conditions precipitate the catatonia syndrome, they are rarely its only etiology. We think that if somatic factors are co-morbid with psychiatric conditions they do not necessarily predominate as the target of treatment. The treatment of the catatonia must be a priority and remain symptomatic, to allow in parallel the specific treatment for the somatic disorder or the psychiatric disorder.

Introduction

Nowadays, catatonia is no longer considered as a subtype of schizophrenia and seems to be more frequently associated with mood disorders, and even with general medical conditions (Fink and Taylor, 2006). In fact in his original description, Kahlbaum defined it as a separate disease, with a progressive, cyclic, variable outcome. He attributed psychological symptoms to it which are similar to melancholy, mania, stupor, confusion or dementia, and motor symptoms (immobility, mutism, negativism, staring gaze, stereotypical behavior, verbigerations, echolalia and echopraxia) (Rosebush et al., 1990). He also reported that it occurred more frequently in patients suffering from mood disorders, which has been confirmed more recently by other authors (Gelenberg, 1976, Taylor, 1990, Brasic, 2006). Nowadays, thanks to certain authors (Rosebush et al., 1990, Taylor, 1990, Carroll, 1992, Carroll et al., 1994, Carroll and Spetie, 1994), DSM IV has recognized that catatonia may also be secondary to some general medical conditions (American Psychiatric Association, 1994). Causes of catatonia are categorized as neurological, psychiatric, psychological, medical, and obstetrical conditions (Brasic, 2006). We can find a helpful history of the recent experience with catatonia and general medical conditions as described in writings by Fink and Taylor (Fink and Taylor, 2003).

We report here 12 cases of catatonia, which we saw over a period of 5 months, during our work in Consultation-Liaison Psychiatry, with the aim of identifying the frequency, clinical features, treatment and precipitating factors of a Catatonic episode, Due to a General Medical Condition (CDGMC).

Section snippets

Method

We collected all the cases of catatonia over a period of 5 months from the 656 requests for Consultation-Liaison Psychiatry Department of the University Hospital of Lille (France). We included all the patients aged more than 18 years old, irrespective of their medical and psychiatric conditions, who were hospitalized in the Medical and Surgical departments (all specialties are present in our hospital), who fulfilled the criteria for suspected catatonia: mutism, psychomotor retardation, odd

Clinical cases

No. 1 (a woman, 22 years old) without any previous psychiatric history (apart from an episode of school phobia lasting 1 month at the age of 14 years old following an appendicectomy) was admitted to the Neurosurgery department to remove a benign tumor around 25 mm in diameter, situated in the midline of the posterior fossa, just above the occipital fossa. There were no immediate complications from the operation, during which the entire lesion was excised.

One week after the operation, she

Discussion

First of all, we saw that catatonic disorders are not so rare in a population seen in Consultation-Liaison Psychiatry, since we saw 12 cases of catatonia out of 656 requests over a period of 5 months, which is a frequency of 1.82%. This result is similar to that of Carroll et al. (1.6%) (Carroll and Spetie, 1994, Carroll et al., 2000), most likely due to the fact that we used the same diagnostic criteria (American Psychiatric Association, 1994). But our frequency is smaller than the result of

Acknowledgements

We thank Brendan T. Carroll for his help in writing our paper.

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